Multiple Sclerosis

• Multiple sclerosis (MS) is a chronic and progressive autoimmune condition involving demyelination in the central nervous system.
• The immune system attacks the myelin sheath of the myelinated neurons.
• Multiple sclerosis typically presents in young adults (under 50 years) and is more common in women.
• Myelin covers the axons of neurons and helps electrical impulses travel faster.
• Myelin is provided by cells that wrap themselves around the axons: Oligodendrocytes in the central nervous system and Schwann cells in the peripheral nervous system.
• Multiple sclerosis affects the central nervous system (the oligodendrocytes).
• Inflammation and immune cell infiltration cause damage to the myelin, affecting the electrical signals moving along the neurons.
• When a patient presents with symptoms of an MS attack (e.g., an episode of optic neuritis), there are often other demyelinating lesions throughout the central nervous system, most of which are not causing symptoms.
• In early disease, re-myelination can occur, and the symptoms can resolve.
• In the later stages of the disease, re-myelination is incomplete, and the symptoms gradually become more permanent.
• A characteristic feature of MS is that lesions vary in location, meaning that the affected sites and symptoms change over time.
• The lesions are described as “disseminated in time and space”.
• The cause of the multiple sclerosis is unclear, but there is growing evidence that it may be influenced by: Multiple genes, Epstein–Barr virus (EBV), Low vitamin D, Smoking, Obesity.
• Symptoms usually progress over more than 24 hours.
• Symptoms tend to last days to weeks at the first presentation and then improve.
• There are many ways MS can present, depending on the location of the lesions.
• Optic neuritis is the most common presentation of multiple sclerosis.
• The diagnosis of multiple sclerosis is made by a neurologist based on the clinical picture and symptoms suggesting lesions that change location over time.
• Disease-modifying therapies aim to induce long-term remission with no disease activity.
• Patients with clinically isolated syndrome may never have another episode or may go on to develop MS.
• Relapsing-remitting MS is the most common pattern when first diagnosed, characterised by episodes of disease and neurological symptoms followed by recovery.
• The symptoms of relapsing-remitting MS tend to occur in different areas with each episode.
• Investigations that support the diagnosis of multiple sclerosis include MRI scans and lumbar puncture.
• Lesions on an MRI scan suggest they are more likely to progress to MS.
• Symptomatic treatments for multiple sclerosis include exercise, medication for fatigue, neuropathic pain, depression, urge incontinence, spasticity, and oscillopsia.
• Active relapsing-remitting MS means new symptoms are developing, or new lesions are appearing on the MRI.
• Primary progressive MS involves worsening disease and neurological symptoms from the point of diagnosis without relapses and remissions.
• Not active relapsing-remitting MS means no new symptoms or MRI lesions are developing.
• A specialist multidisciplinary team (MDT) manages multiple sclerosis, including neurologists, specialist nurses, physiotherapists and occupational therapists.
• Relapsing-remitting MS can be further classified based on whether the disease is active or worsening.
• Multiple sclerosis (MS) is a condition that affects the central nervous system, causing symptoms such as numbness, tingling, and paralysis.
• Clinically isolated syndrome describes the first episode of demyelination and neurological signs and symptoms.
• Symptoms of secondary progressive MS become increasingly permanent.
• Secondary progressive MS is where there was relapsing-remitting disease, but now there is a progressive worsening of symptoms with incomplete remissions.
• Secondary progressive MS can be further classified based on whether the disease is active or progressing.
• Relapses in multiple sclerosis may be treated with steroids.
• Oscillopsia refers to the visual sensation of the environment moving and being unable to create a stable image.
• Patients presenting with acute loss of vision need urgent ophthalmology input.
• Lhermitte’s sign describes an electric shock sensation that travels down the spine and into the limbs when flexing the neck.
• Multiple sclerosis may present with focal weakness, for example: Incontinence, Horner syndrome, Facial nerve palsy, Limb paralysis.